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 The NeuroGuide Affiliate Program

National and International to Train Students and Clinicians in QEEG, 3-Dimensional Electrical NeuroImaging and Neurofeedback Using NeuroGuide

 

A Single Unifying Concept to a

Modular Approach to Learning

qEEG and Neurofeedback: Link the

Patient’s Symptoms to the Patient’s Brain (LSB)

There is a growing need for standardization and the application of modern science to the field of quantitative EEG (qEEG) for brain assessment and EEG Biofeedback. Over the last two decades there has been an explosion of modern neuroscience information about brain networks and dysregulation in networks linked to patient's symptoms. Over 30,000 PET and fMRI studies have been summarized and show high consistency and reveal fifteen basic networks that mediate diverse brain functions. Cross-validation of fMRI, PET with EEG electrical neuroimaging (e.g., LORETA) has also been published and these efforts now make it possible to link patient's symptoms to dysregulated networks in the brain and then to design neurofeedback protocols to reinforce increased stability in the relevant nodes and network connections.

There also is a need to teach students and clinicians how to use NeuroGuide and the various neuroimaging and neurofeedback tools to seamlessly move from assessment to hypothesis formation about the most likely networks linked to symptoms to testing hypotheses by qEEG assessment to neurofeedback protocol formation. The recent scientific developments in neuroimaging and EEG biofeedback provide for the creating of a single unifying concept to facilitate learning and achieve standardization at the same time. That unifying concept is: "Linking Symptoms to the Patient's Brain".

The Goal is to minimize power point presentations and academic lecturing and instead maximize hands on procedural memory. Another goal is to empower the clinician with efficient and accurate EEG editing and Automatic Clinical Report Writing (ACR) as well as the use of NeuroLink to identify the troublesome symptoms and to evaluate treatment efficacy over sessions.

1- No Beginners vs Advanced Grouping – Each Module is stepwise from basics to advanced keeping in mind the single binding concept of LSB shared by All Modules.

2- All Modules Contain Essential Parts of the LSB and are Presented with Power Point Images.

3- Emphasis is on Hands On Experience - let attendees edit EEG and create an automatic clinical report

4- Let attendees produce Neurofeedback protocols and learn seamless integration of symptoms to hypotheses to qEEG to Neurofeedback in one session

5- All Modules are Supported by Webinars, a Free e-book, 10 free ACRs, 10 free NeuroLinks (a $700 value). Marketing Material and Skype when Robert Thatcher, Ph.D. is available

6- BCIA Credit and APA CUs Where Possible: Based on State Organization Credentials

7- Teaches the QEEG-Certification Board Blueprint

8- International NeuroGuide Affiliates are Encouraged to Collaborate with Certification Bodies/Agencies and Provide Continuing Education Credits in Their Respective Countries

9- Add one's own assessments and share one's experiences while presenting Neuroguide

10- Encourage hands on experience and refer to the over 200 pages of hands on tutorials inside of the free ebook version of the "Handbook of QEEG and EEG Biofeedback"

11- Challenge attendees to prepare before the workshop by viewing the free webinars and challenge them by hands on experience with symptom assessment, network hypothesis formation, good recording hygiene and then testing the hypotheses to linking symptoms to dysreguated brain networks followed by neurofeedback to reinforce stability in the relevant nodes and connections

12- Iterate and summarize at the beginning of each day so that attendees are empowered with minimal theory and a lot of practical experience.

Standardized Content of Workshops

Supported by Webinars & Skype Participation

Clinical Modules

  1. Clinical Assessment & Hypotheses to Link Symptoms to Networks

  2. Good Collection Hygiene

  3. Visual examination-Location of deviant spikes, waves & bursts, remontaging

  4. Artifact Rejection – reliability & multiple unbiased selections

  5. FFT & JTFA power & coherence analyses- Linked ears & Laplacian – Hypothesis testing

  6. LORETA 3D Node and Connection Analyses – Hypothesis testing

  7. Automatic Clinical Report (ACR) Production and Symptom Linkage to Brain Networks

  8. Functional and Effective Connectivity to Identify "Compensatory" and "Weak" Hubs

  9. Neurofeedback – Symptom Check List & Networks targeted to "weak" systems

  10. Pre vs Post Assessment Maps and NeuroStat and Self-Assessment Questionaire changes

  11. Revise protocol depending on symptom change

Research Modules

  1. NeuroStat & NeuroBatch

  2. Burst Metrics and Bi-Spectrum

  3. Connectivity Suite

  4. Cross-Spectral Co-Modulation & Phase Reset

  5. Effective Connectivity - Information Flow in Networks

  6. Electrical NeuroImaging

Example

NEUROGUIDE WORKSHOP OUTLINE

 

A Modular Approach to Linking Symptoms to Dysregulation of Networks in the Brain

1st day - A Practical Hands on Approach: How to go from Clinical History to EEG Acquisition to QEEG Analysis (including LORETA). Learn about New add ons, such as the Automatic Clinical Report Writer, NeuroLink that allows the clinician to rank the symptom check list with 10 different categories of symptoms and radar maps and line graphs to evaluate the progress of treatment. Introduce the idea of linking symptoms to networks in the brain and explain the tools available in Neuroguide to measure functional connectivity and the magnitude and direction of flow of information between Hubs (Brodmann areas). Measure the EEG and demonstrate editing and ACR and Neurofeedback protocol generation followed by Neurofeedback.

2nd Day – Brief review of day one with emphasis on a 2nd Hands on EEG recording to Assessment (ACR report production) to Z Score Biofeedback in a Single Session and Add Ons (LORETA Coherence, LORETA Phase Differences, LORETA Phase Reset, Effective Connectivity or Information Flow) and New Advances: Automatic Clinic Report and Effective Connectivity and a hands on Demonstration of Surface, LORETA Neurofeedback and BrainSurfer

 

Day One

One hour to 1.5 hours of introduction and minimal slides. Minimize academics like the genesis of the EEG or details about spectral analysis or discriminant functions, etc. I have found that many already know this and for those that do not the information goes into one ear and out the other. Attendees can learn the academics by a google search or textbooks that many have at their homes. The goal is hands on teaching or "Learning by Doing" so that clinicians are empowered to leave the workshop with procedural memories and to follow the step by step procedures taught to them. Teach the items below by example and encourage attendees to learn the academics of neurophysiology from textbooks and the internet. Concepts like connectivity and synchrony need to be mentioned but scientific details are not necessary to teach in a workshop that is designed to empower clinicians. Main focus needs to be: 1- Editing, 2- producing a clinical report through the Automatic Clinical Report Writer (ACR) and 3- Neurofeedback complete within 30-40 minutes.

1. Start with about 1 to 1.5 hour introductory lecture with slides. Discuss the importance of knowing the patient’s clinical history and symptoms and then to hypothesize how the brain’s localization of function properties are liked to the patient’s clinical history. Explain why one can use LORETA to confirm localization hypotheses to help link the localization of the "weak" functional systems of the brain related to the patient’s symptoms in contrast to "Compensatory" systems.

2. Teach how to import digital EEG data and to visually examine the EEG tracings and how to recognize artifact and how to re-montage (average reference, Laplacian, Bipolar, common reference by a mouse click). Teach how to eliminate the effects of medication by using the Laplacian transform.

3. Teach how to Automatically Eliminate artifact and how to measure the Test Re-Test Reliability and the Quality of your recordings. Demonstrate how to examine EEG traces and dynamically link visual events in the EEG tracings to the QEEG. Teach how to avoid bias in the selections of EEG for QEEG analysis.

4. Teach about the Automatic Clinic Report Writer (ACR). Show the logo and business affiliation, page and then the options page and then immediately produce a report in about one minute. Repeat this two or three times so that the clinician immediately feels empowered and knows that they do not need to learn the old world method of creating and saving maps and then copying images - this is something from the past that does not need to happen. Encourage attendees to practice creating their own ACR reports in the Demo mode.

5. Demonstrate how the maps and information in the ACR were produced, i.e., click Report > Report Selections and Generate Report and also Analysis > LORETA > LORETA Current Density so that attendees know where the ACR comes from and that they can manually do what the ACR does if they need to.

6. Teach how to use NeuroLink for self-assessment and to evaluate changes in the severity of symptoms over time.

7- Teach how to interpret power, coherence and phase delays in terms of anatomical information and again link to the patient’s symptoms.

8- Teach the importance of the Playback of patient's EEG to test and learn about linking symptoms, the symptom check list, networks and how the progress chart changes when one changes the Z score threshold. In the Demo Mode import the demo patient's EEG (age 55 eyes closed). Edit and do the ACR and then review the content and show how report links symptoms (spatial neglect, paralysis on the left) to the patient's brain. Then click Report > Symptom Check List Match (.scl) to prepare for NFB. Then click Collection > Hardware Selection > Playback and then Collection > Setup & Monitor and OK. Then activate LORETA NFB, open the symptom check list, select a symptom(s) and networks and demonstrate how the symptom check list produces a NFB protocol.

9- Demonstrate the differences between "Z Tunes" and all-or-none and average. Point out that average should be used with caution because one can inadvertently reinforce outliers and extremes. Demonstrate the use of the "Rounds" and how the playback can be used to prepare a NFB session before the patient arrives.

10- Demonstrate the use of the Intersession progress charts to evaluate changes.

 

Day Two

1. Review assessment and linking symptoms to dysregulation in networks of the brain. Emphasize that EEG frequency or metric deviation from normal are less important than location, location, location. Repeat the ACR demonstration

2. Review the importance of synchrony in local hubs that produce EEG amplitude and structural connectivity, functional connectivity and effective connectivity.

3. Do an EEG recording from a volunteer and demonstrate good recording hygiene. Then demonstrate editing, .scl production and the ACR.

4. Teach how to develop an individualized neurofeedback protocol based on the strategy to minimize abnormal EEG deviations integrated with other measures including the patients clinical history and the clinician’s judgment.

5. Use the symptom check list and Information Flow (Effective Connectivity) to hypothesize "weak" vs "compensatory" brain systems and to automatically create a 19 channel Z Score biofeedback protocol based on the match of hypothesized weak systems to deviant QEEG Z Scores. Explain why compensatory systems are sending information while weak systems are receiving information as measured by Effective Connectivity

6. Review how to use LORETA NFB and the Playback procedures used the day before.

7. Teach how to use BrainSurfer – Network NFB of current density, LORETA coherence, LORETA phase differences and LORETA phase reset

8. Review the connectivity metrics in Neuroguide: 1- Coherence, 2- Phase Differences (Delays), 3- Phase shift and lock duration and 4- Information flow.

9. Ask attendees to bring patient's EEG to review and be prepared with one's own EEG cases to review.

If There is a Day Three - Review and Advanced Topics

Practice, Practice, Practice with minimal Power Point Slides and minimal Academic Lecturing

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